Provider Demographics
NPI:1710170725
Name:LEONARD TREMBLAY, MD PLC
Entity Type:Organization
Organization Name:LEONARD TREMBLAY, MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TREMBLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-524-3215
Mailing Address - Street 1:53 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-4405
Mailing Address - Country:US
Mailing Address - Phone:802-524-3215
Mailing Address - Fax:802-442-4778
Practice Address - Street 1:53 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-4405
Practice Address - Country:US
Practice Address - Phone:802-524-3215
Practice Address - Fax:802-442-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014193Medicaid
VTDH1206OtherRAIL ROAD MEDICARE
VTDH1206OtherRAIL ROAD MEDICARE